Ruminations by a non-academic general surgeon from the heart of the rust belt.

Thursday, September 16, 2010

Get Rid of the 4th Year of Med School

A poorly kept secret amongst recent med school grads is the fact that the last year of medical school is a complete joke and waste of time. Most 4th years will do rotations in July and August in the specialty they hope to match in, for the purpose of cozying up to attendings for recommendation letters. But after that, it's a 6 month vacation until match day. I did a surgical ICU rotation in July and then followed that up with a stint on cardiothoracic surgery. I spent the rest of the year half assing my way through rotations like radiology, anesthesiology, and pathology case studies. Most days I got to the gym around noon for a 4 hour session of pick up hoops. And oh yeah, I borrowed about $35,000 to finance that lifestyle.

There are two main reasons to reorganize medical school education along the lines of a three year program. One, it's a waste of loan money and squanders a year of earning potential. Two, it just may be a contributing factor in driving more students out of internal medicine, primary care, and general surgery.

Let me explain. If you eliminated the fourth year, students wouldn't have the oportunity to rotate through subspecialties like dermatology and radiology and cardiology and orthopedics. Hence, less chance to be brainwashed into thinking that general medicine and surgery were beneath them. The third year curriculum would expand the exposure to internal medicine and general surgery and family practice. Someone who really really wanted to do a cardiology rotation could do so, but would have to eliminate either OB/gyn or psychiatry. As it is now, the entire fourth year is built around the idea of winning praise from subspecialist academic physicians. Is it any wonder that medical students look down upon the "mere generalist" professions?

17 comments:

1:Radiology: actually stayed 2 hrs a few days, No Call2:Surgical Pathology: Stayed 2 hrs most days, Attending that month was really hot and all we did was sit around looking at pap smears.No Call3:CT Surgery: required "Surgical Subspecialty rotation" actually had to work on this one. 1/3 call4:Neurology: required "Neuroscience" rotation, doing consults for Neurology residents who didnt talk good English. No Calland 4 Anesthesia rotations, some of my Orthopedic inclined friends did 6 Ortho rotations. 1/week anesthesia call, but you got the next day off.

As a MS-III at a private medical school with crazy high tuition I can certainly see the merit in something like this- the idea of doing primary care would be a little farther forward in my head if I knew I could shave off an extra 50k of debt. Doing a little looking around, it seems that there is already a program like this (Primary Care Scholars Pathway) in place at the DO school in Erie PA. http://www.lecom.edu/pros_pathways.php/primary-care-scholars-pathway/76/0/1955/7361

I don't know much about this program other than what's on the website, but thought you and others might be interested.

Jeez, you guys got ripped off,My Med School was only $6,000/yr, which I couldn't afford cause it was 1984 and that was alot of money back then, so got Uncle Sam to pay for it, all he wanted was 4 years of my time, not like I was gonna do anything else, and anyway, I always wanted to go to Iraq.

I think part of the problem with fourth year becoming more useless is that third year has also become useless. Liability digs its fingers into every aspect of the academic hospital, and students have been reduced to useless parrots putting redundant notes into electronic charts. The value of the co-sign is useless when it takes the resident more time and clicks to co-sign the student's order than it does to put in their own order straightaway. Blood draws? Nope, now there's "phlebotomy teams." Keeping the list updated, transport, dressing changes? Well the dean's office doesn't want the students getting "scutted out" so residents are now "strongly discouraged" from passing along such things to students. Students don't manage their own patients anymore because all the "work" aspects of the clinical years have been stripped away. As a result it gets harder to land important procedures like central lines because the interns take seniority and are still trying to become comfortable because THEY didn't learn them in med school either.

If you're going to keep the fourth year, at least let me function like a "sub-intern". Let me do the things that interns do so that I am competent when it my turn. Then "maybe" the tuition would be worth it. As it stands right now, I'm not going to learn any more until I'm allowed to work, so just make me a resident and let me start working already.

Hmm, I actually managed to showcase from July until December of my 4th year, and I worked really hard on all of my rotations. They were all at competitive surgical programs, so I definitely had to be there early and stay late everyday. I didn't take call nearly as much, but that lack of stress was made up for by going through the application process.

The monetary argument makes sense. Although if programs want to continue to interview applicants, there will be some 2-3 month span of time that is going to be rendered useless in any format. Might as well put that lost time in a useless year instead of in the middle of the major clinical year.

The mandated sub-specialty ignorance idea is pretty silly. I challenge you to find 5 med schools that have a significant third year rotation in opthamology. Optho is an early match, and applicants have to basically decide on it by the end of third year. Now go look at the applicant statistics for optho, and you'll notice it's one of the most competitive specialties out there. Med student aren't livestock that can be herded into poorly compensated unsatisfying specialties.

Getting rid of the 4th year of Med school is not going to happen because the banksters have got to make their 5% on that extra debt. Jamie Dimon the CEO at JPMorganChase won't hear of this and you know they fund both parties to enable their enrichment laws. I mean laws to benefit the people especially doctors who help save and make lives better. The good thing is that Obama will make the maximum amount of student loan payments only 10% of your monthly income. Ironically Obama campaigned in the image of Abraham Lincoln even though Lincoln was a Republican not a Democrat. Also Lincoln issued the Greenback to fund the fighting of the Civil War which the bankers weren’t in favor of because it wasn’t loaned into existence. This meaning that the money issued to fight the war didn’t have interest attached. Lincoln realized the Congress had the power to issue the United States currency with out interest to bankers. Call me a radical, I like to think I just have an open mind to question long established norms. Why should medical students with the mental capacity to gain entrance and pass the rigors of the curriculum have debt given the future societal benefits realized from their sacrifices? Why was the Contraction of 1866 passed or the Coinage Act of 1973 passed?

Another thought is gtting rid of the four years of undergraduate college required for entry. Have a combined five year program. That would save time and money. It seem to work well for thoer countries.

I agree with ribates. In our 4th year we were given the option of being an 'acting intern'. Deciding what specialty you want to go into cannot be made maturely in your third year of med school. I noted that most 'surgeons' felt this way, and maybe it has something to do with that. I do think for someone going into primary care the fourth year should be more like the beginning of residency training. Actually in the next ten years the paradigm for payments will see a marked reduction in payments for specialists down to about 250,000 per annum overall and an increase for primary care to about the same level. Times do change.....

Why not expand the third year curriculum so that it covers two years? That would allow more in-depth exposure to the basics, which would produce more well-rounded physicians of every specialty, hopefully enhancing respect between the specialties.

It's bummer that we are forced to spend so much time and money to get into and graduate from med school, only to emerge in a world where doctors are often under appriciated and under paid. We need healthcare reform but the Obama administration's "healthcare reform" isn't exactly ideal.

I say get rid of the first yearof med school because in the 16 years since I have graduated from med school I used or remembered exactly 0.002193% of what I learned!!! In fact knock of high school too cause I wasn't into school back then..oh yeah and cancel college because I drank alot and really don't remeber to much..shit I could be just a smart and thousands and thousands of dollars richer if I had just shown up for my surgical residency..wait I didn't really "do" much surgery the first year.....it is amazing but having done alot of training in Europe I am amazed by the differnces in philosphy of live, work, and medicine. In the US you listen for heart sounds so that you can bill for it, you read an xray so that you can "generate income", you take people to the OR to "get re-imbursed"...it is all so sick!!!!!!!!!!

Have you ever thought, that maybe, just maybe, students who wish to Dermatology or Radiology actually like those specialties? Amazing, I know! There's a reason we don't want to be IM doctors, FM doctors, or Surgeons. Mainly bc the work is BORING, mundane, and any glutton for punishment can do them. It's not our fault, that you weren't smart enough to make AOA.

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